Handling Cold Weather Injuries in a Survival Environment

This is a guest post by Joe Knight 

First Aid For Cold Weather Injuries

After TSHTF, you may be in a situation where you may be living in the woods to avoid the chaos that is sure to strike after the rules that hold society together unravel. If the weather is warm and nice, that won’t be a problem for those who have psychologically prepared themselves for it. Chilly and rainy might make you miserable, but surviving such conditions is still not going to be a problem.

The real challenge is going to be not only surviving, but living, during the winter. If you’re in the southern climes, that shouldn’t be a problem; however, if you live in the northern part of the country, winter generally means cold and snow. You know you can’t stay sheltered in the snug little cabin you had built when things were “normal”; at some point, you’re going to have to get out in the weather for hunting, scouting or chasing-down potential or real enemies.

Being exposed to the weather is going to be a prime consideration. Stress, lack of proper nutrition or lack of preparation is going to make you a prime candidate for a cold weather injury, also known as a CWI. How you manage a CWI can mean life or death.

Obviously, avoiding a CWI is always the best idea, but what are you going to do if you, a loved one or a companion becomes a casualty of the cold weather? In a pre-SHTF world, one could always go to the hospital where you will have the best possible care and have a good chance of a positive outcome, but in a post-SHTF world, such luxuries aren’t going to be available, so it’s going to fall on shoulders of the person who has been appointed as your tribe’s health care provider.

In this article, I will describe the four types of CWIs and how they should be managed on a post-SHTF world where “health care” as we know it today no longer exists.


Chilblains occur when the cold weather causes the blood vessels to constrict, and the most common site for chilblains is the feet. A person with chilblains says he feels like he’s walking with stones in his boots. When you examine the person’s feet, they may feel cool to the touch and may have pale areas on the soles. Chilblains are more of a nuisance than a serious problem, but the person with chilblains isn’t going to be operating at maximum efficiency; this could be a problem if you’re hunting or fighting marauders. Not only that, but if chilblains aren’t treated appropriately, they can evolve into a more serious medical issue.

The treatment of chilblains is pretty simple. Have him remove his boots and socks, and gently wash his feet in warm (not hot) water. Wrap his feet in a warm towel and keep him off his feet for around 12 hours if possible. The circulation should start normalizing, and you can then continue your mission. If he still has pain after 24 hours, he should head back to the cabin and kept warm for about a week.

Immersion or Trench Foot

Though technically there’s a distinction between “immersion foot” and “trench foot”, for the sake of this article, they’ll be considered the same thing.

If one’s feet are constantly exposed to water, especially cold water, the skin get’s waterlogged and is prone to breaking down. The feet look rather repulsive – they’re wet, shriveled and are generally numb. Blisters usually develop, and these can break. When that happens, you are now dealing with open wounds at a part of the body which is receiving a poor blood supply. This is a prime area for an infection to develop, and the last thing anyone needs in a post-SHTF world is an infection.

Like chilblains, treating a person with immersion foot is pretty straightforward. Dry the skin carefully, trying not to break any blisters. DO NOT apply, butter, grease, lotions or any other weird stuff. Confine him to bed with his feet elevated and exposed to the air. If the blisters break, gently dab off the fluid and apply an antibiotic ointment to the open wound. He also needs to stay off his feet. If all goes well, he should heal-up in a week-or-so.


Hyperthermia occurs when a person’s core body temperature drops to a dangerous level. One of the most common causes of hypothermia is sitting around the campfire in the dead of winter and getting drunk and stupid.

Knowing someone is hypothermic is pretty easy; he gets what health professionals call the “umbles” – he fumbles, stumbles and grumbles and is basically not acting like his normal self; the blood reaching his brain is cold, so it doesn’t work the way it usually does. The shivering mechanism, which is the body’s attempt at generating heat, may shut down, his speech becomes slurred and he gets confused. As the body’s core temperature continues to drop, he’ll become sleepy, his heartbeat will slow, and then he just…dies. Assuming this may be someone you care about, you need to get into action quickly.

If near your cabin, get him inside and strip him down to his underwear. If he’s still coherent, he may just need a blanket and something warm to drink. But since this article is written assuming the worse-case scenario, drastic measures need to be taken. Place him on a blanket and strip him down to his underwear.

Then you and your buddy need to strip down to you underwear. Each of you needs to snuggle-up to your bud and keep yourselves covered with blankets. The purpose of all this isn’t because of some kinky sexual thing – what you’re doing is transferring your body heat to your buddy. When your buddy’s core body temperature starts to rise and he starts coming out of his lethargic state, be ready for some potential violence; people coming out of anesthesia or warming-up from hypothermia can get combative (the fact that he’s waking-up with his two half-naked buddies snuggled-up to him isn’t going to go over very well either).

Once he’s reasonably alert, give him something warm to drink (avoid caffeine). Once he’s fully awake and alert, you can then explain to him how grateful he should be that you and your other friend liked him enough to strip to your skivvies and wanted some snuggle time.

One other thing – no matter how good he feels, he needs to stay put for 24 hours and drink warm liquids. It is at this point many folks coming out of hypothermia are encouraged to get up and walk around. It is also at this point where many of these people drop dead because the heart can stop when cold blood reaches it. That’s the main reason to keep him resting for 24 hours; if you need to get back to your cabin, build a travois and haul his butt back on that.


What most people call ‘frostbite” – isn’t. Frostbite means something specific, and is divided into four degrees: First degree, second degree, third degree and fourth degree.

First degree frostbite (also called ‘frost nip”) involves the freezing of the top layer of skin without the formation of blisters. First degree frostbite is easy to treat – all one has to do is to warm their hands or feet, but never by the campfire or stove. The nerve endings are frozen, so the person can’t perceive heat very well, and can wind-up with a first or second degree burn without realizing it until it’s too late. If his hands are affected, have him place his hands in his armpits until the fingers are warm. If his feet are affected, you can play hero and let him place his feet in your armpits until the feeling returns to his feet.

Second degree frostbite involves the formation of blisters, which can be filled with clear fluid. The treatment of second degree frostbite is treated just as immersion foot mentioned above.

Third degree frostbite involves a bluish-gray discoloration to the skin (due to lack of good blood circulation), and the formation of blisters, usually filled with blood. In a post-SHTF world, there’s not much you’re going to be able to do for your friend except treat the hands or feet just as you would second degree frostbite. The problem you may have is some skin may die and slough off. The best you’re going to do in this type of this situation is treat the open wounds as you would any other injury and try to prevent infection. Another problem is that the affected toes or finders may shrivel-up, mummify, die and fall off. As disgusting as this may sound, this is the body’s way of getting rid of non-functional body parts. If the person survives this, he should be OK after a month-or-two.

Fourth degree frostbite is obviously the most serious type of CWI. In this case, the skin is frozen down to the bone. If you or your bud gets fourth degree frostbite, several things are going to need to be kept in mind: First of all, there’s a good change whoever is afflicted will probably not make it. It’s not the CWI that’ll kill him – it’s usually the infection that follows that’s usually fatal. To try to increase the odds of your friend surviving, the following precautions need to be taken:

First of all, if a limb is frozen solid and you still need to travel, do not allow the limb to thaw. Even if the person has to walk back to the cabin with a frozen leg, it’s better that way. If a limb freezes, thaws then is frozen again, tissue damage will be much greater. Also, if it thaws before you get back to your cabin, you’re going to have a horrendous mess on your hands as the tissue thaws – blisters that form will then break and leak, dead skin and muscle tissue will be sloughing off…you get the idea.

When you get your friend to the cabin, all those horrible things I just mentioned are going to happen. If your friend is “lucky”, the frozen limb or digit will just mummify and fall off, but it’s best to prepare for the worse. Dead tissue is a wonderful breeding ground for bacteria, which can then enter the bloodstream and start a generalized infection from which few survive.

The best way of treating a CWI is preventing it in the first place. Proper nutrition, proper clothing and common sense should help prevent the problem. You’ll have enough to worry about in a post-SHTF world. A CWI shouldn’t be one of them.


Bio: Joe Knight is a Physician Assistant and a medical writer in Chowchilla, California. During his 20-year military career, he was a Battalion Surgeon in the Arctic Infantry Brigade at Fort Wainwright, Alaska.


  1. Excellent article. Being a Northeast cabin dweller I appreciate all the information. Last winter was quite severe with record setting snowfall not seen since the Blizzard of ’78.
    I broke away from the fashionista mode to a more practical way of dressing for inclement weather. Especially by investing in sturdy, waterproof boots(2 pair.) No high heels for me.
    From earmuffs to boots, I’m covered. In layers.

    I’m printing out this information. Good stuff.

  2. I’ve had frost bite twice. It can happen fast especially when your active and your mind is preoccupied. The first time was when I was riding my motorcycle in the new England winter with nothing but a single layer of clothing between me and old man winter. The second was when my truck broke down in north Minnesota on a balmy winter day(in think with wind chill it was -30) I was standing outside working on it with a wife and dog huddled in the sleeper trying to stay warm. Both times I had skin blister and peel off. Much earlier before the don’t ask dontell army. There was a guy that constantly complained of having hypothermia,even in the summer. Later he became an interior decorator. Brad

    • Be truck
      Once ya get it it does not go away..I have blistered to..
      Grew up on the shores of Lake Erie. As kids all-ways out in the cold
      having fun.. Still cannot feel my toes,, my were blueish and blistered..
      as I rember.. Any ways I find the interior decorator very comment funny!
      I was in placo in the mid to late 60’s with cold toes and fingers..
      Still do not feel like interior decorating!!!LOL Parts of my skin is like some what reptilian or permanently calloused and always cracking on my hands and feet.. From the bit I suppose. Nasty stuff! Watched some of you excellent videos. Your hand appear extra rough,, Is that from the big truck or does it go away?? from time to time.. Hope it does..
      Mine does not go away to often.
      Be careful all or you will get the desire to be come an interior decorator from the bite… Hey they make good money!!
      Watch the cold all it can kill ya!! easier than the heat I think my 2 ¢…………

      • Thataway,
        Both my hands have been mashed,cut,sliced and diced on various machinery when I worked in my dads machine shop from the age of 13 till I joined the army at 17. Glad you liked my vids. Brad

        • Brad
          I am sympathizing you brother , the hand and parts
          get kinda funky looking after to much abuse..
          You are younger than me. I can see from you videos.
          I just hope it does not haunt you. Stuff hurts the damage that you
          do when you are young.
          MMM! Did a quite few trip around out of Ohio and back to the W. Coast
          with my best and himswife’s trucking company. Was a bi weekly thing.
          He got sugar and went blind lost his feet and I think you know the
          rest of the story
          Smart move you did joining a big company I was self employed for ever,
          that can get you to Well do not want to be a bummer..All head had was those junky Peterbilts. I am not into the truck that much just drove some..
          His were truck beautiful, a couple of them went around the world 2 or 3 times buy the time he sold them..
          Later Take Care

  3. During Winter exercises in Germany with the US Army, the company medic would have us take our boots and socks off, then squeeze each toe and release. If it turned white and then red again on release, indicating the blood left and returned, we were ok. Everybody always was. This was done once or twice a day. Since the FARP was always separate, we only got checked by a medic once per day, but once you understood it was a simple self test. Rock of the Marne!

    • Another good tip. What you mentioned here makes good common sense, it’s just not something I’d heard of before, nor would have thought of I suspect.

    • Grafenveer?

      • Been there (and Hohenfels), but no, aerial gunnery was always decent weather. My attack helicopter battalion would set up in small towns renting barns and such. With the birds gone you would hardly know we were there, just commo wire all over town. The fuel platoon (with me until I became HHC CO’s driver) would set up just inside a nearby treeline.

      • Ah, good memories… Spent close to 10 years as an alpine training instructor working out of Garmisch and Bad Tolz. Always taught soldiers to place their bare feet dead center on a comrade’s bare chest if suffering from 1st degree frostbite, but under the arm does seem more efficient though.
        Good article Joe, thanks for taking your time to share the info with us.

    • AZ Rookie Prepper says:

      It gets doggone cold in Korea too. Coldest I’ve ever been was there, near the Chinese tunnel. Canteen froze solid in 15 minutes and cracked.

  4. Lint Picker (Northern California) says:

    I prefer the guest articles that explain how to avoid problems as well as how to deal with them. This article covered both prevention and treatment. Thanks for that, Joe Knight.

    It used to be that wool was the go-to fabric for cold climates. Now there are synthetic fibers that are much better. However, the people who really know how to deal with cold weather are those who live in the Arctic Circle – they wear fur. Sure, that’s all they had for thousands of years, but in a SHTF or TEOTWAWKI situation, reverting to wearing fur may be a necessity and a lifesaver in cold climes. What’s your perspective on this, Joe? Is fur the best or is synthetic superior?

    • Hi Lint,

      I will be interested to hear what Joe thinks about this issue, when I was in the arctic, I got a full length jacket with the coyote hair trimmed hood, and it did a great job, way to hot unless it get below 40 where I am at now to wear but its nice to have in storage for just in case.

      I also have a set of Boo skin pants and amauti style Seal skin parka, I have seal skin long mitts but also have a fancy pair of artic fox mitts for when we went to the local feasts (think dress up mitts)

      I was able to go to the local fairs and hand pick out the seal hides I wanted and had them custom made locally in Iqualuit. I love my collection of different furred trapper hats, my dad tries to find me a new one every couple years in a fur that I don’t already have..

  5. Excellent article, both in content and style and that you were able to ‘lighten up’ some pretty serious stuff. Good job!

  6. Joe,
    Good information. We teach similar information about frostbite and hypothermia in our Hunter Education classes, and the one thing I’d like to add to the discussion is something you should already have done amongst your companions anyway, and that is to know who has any medical conditions. Certain medical conditions can accentuate or mimic CWI. The specific one brought up by a fellow instructor was diabetes. When a diabetic starts to go hypoglycemic (low blood sugar) one of the symptoms is those same “umbles” you would see in hypothermia, so knowing someone has a medical condition can help you make sure you know that you’re treating the correct ailment. As much as I might like my friends, a glucose tablet or Snickers bar beats cuddling time any day, at least for me 🙂

  7. Lived in both extreme heat and extreme cold , I noticed that things seem to hurt more in the cold lol .

  8. Excellent article.. thanks for such a wonderful guest post!

  9. Matt in Oklahoma says:

    Good Article

  10. FANTASTIC article! This is a keeper for my survival health binder. Thank you so much.

  11. Jennifer (Prepping Wife) says:

    I really liked this one! It’s gonna go into my binder! I hope this is one of the prize winners!!!!!!!!!!!!!!!!!!

  12. SrvivlSally says:

    Joe Knight, I am going to be surprised if you do not win. Thank you.

  13. Excellent, to the binder this article goes. Thanks.

  14. The one comment addressing animal skins reminded me about a study I read, I believe conducted by the University of Alberta. They had students sit inside a commercial freezer at 30-40 below Centigrade in various clothing and test their hypothermic response. They tested items such as thinsulate, goose down, wool and reindeer skins.

    The synthetics actually fared poorly compared to the natural insulators such as down feathers. Reindeer skins (made into suits) performed the best. What was particularly interesting was that treated skins let the students sit in sub-zero temps for hours whereas when wearing uncured (untreated) skins, their core temperatures never dropped regardless exposure time. Problem with uncured skins, when the temp goes up, they rot and then you have to get new ones.

    • Hi James,

      I will have to google and see if I can find the article but I can believe it, We often had outdoor games in early spring, and its still cold then, the native gear would let you go all day if you wanted, interesting about the uncured skins, I would like to read it, do they mean truly uncured or do they mean the difference between a natural cure with brains or raw egg rubs vs chemical cures.. hmmm.. off to see if I can track down that study..

    • When I was in Alaska , I did buy 2 reindeer hides , very soft and yes very warm . Wanted to get two more but when I went back a few years later , the price had skyrocketed . just keep my two and be happy .

  15. Hmm, an un-cured deer skin snow-mobile suit – that is sure to cost some big bucks.

    As a Michigander the local advice is “dress in layers”, then you can shed a layer or so if the temp starts to rise. Since, I did do some snow sledding, I have a nice warm snow suit which will keep me warm in -40 F plus the 70 mph wind chill factor. It uses layers even in the gloves.

    This article is relevant when the Nuclear winter comes – it would be “winter” for almost 2 years straight.

  16. Worrisome says:

    Great article Joe! Candidly, even tho I live far enuf north that I should have concern? I haven’t been as concerned as I should be…….Back to the lists and things to get to stay healthy!

  17. AZ Rookie Prepper says:

    Joe, Good article. Reminds me of much of my winter training in Korea and other not so warm locations. Thanks for a good bit of info and reminders.

  18. Givemeliberty says:

    Useful article, from this M.D.’s perspective.

    Good job.

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